Florida Medicaid changes draw criticism
Florida Medicaid changes draw criticism
Florida's efforts to revise its Medicaid system, beginning with 200,000 people in Broward and Duval counties and then phased in statewide, have drawn criticism from advocates for Medicaid recipients even as the governor projects better care for the state's most vulnerable citizens.
"I am delighted and honored to sign into law the single biggest change and the boldest reform that any state has embarked on for the Medicaid program," Gov. Jeb Bush said in mid-December. "I am absolutely confident that this reform will yield better health care results for Florida's most vulnerable citizens and create more predictability in management of our costs."
But Families USA executive director Ron Pollack accused Mr. Bush of "speaking out of both sides of his mouth. First, he brags about the importance of this proposal because it will save significant money for the state. Then he promises that the state's seniors, children, and people with disabilities who rely on Medicaid for their health care safety net won't be hurt. In the real world, you can't have it both ways. The governor's actions still undoubtedly will result in higher out-of-pocket costs and the withholding of care for the poorest residents of Broward and Duval counties. In the end, it will cause people to go without care and force them to pay more for the care that they do receive. The harmful impacts of this waiver should not be underestimated and should be carefully analyzed before this proposal is extended to other Florida counties or to other states across the country."
Under the plan, Medicaid recipients will choose from among state-approved "provider service networks" to coordinate their care. The government will pay a premium, with the amount varying based on each person's health, to the managed care groups. The theory is that those in the plans will see doctors more often and thus problems will be caught earlier. Managed care plans will have an incentive to keep their patients well and avoid the expense of treating major problems later.
"It's a shift from a system that reimburses providers based on sickness to a focus on wellness," Mr. Bush said. "That is a radical change."
Proponents said Medicaid recipients will be given more choices under the new plan and will be provided incentives if they participate in preventive health care programs like making sure their children receive immunizations or participating in a smoking cessation program.
Another key component is the use of "choice counselors" to advise Medicaid recipients on selecting health care providers in the new system.
"Those who want to defend the current system are defending the indefensible," said state Agency for Health Care Administration secretary Alan Levine. "Only 4% of all women in the Medicaid fee-for-service program are getting mammograms. That's absurd. That's not a successful system; that's a failure."
Limiting growth
The program is structured to limit cost growth to 8% over the next five years, although there are allowances for enrollment growth.
"Everybody in the Medicaid system is going to be hurt by this because Florida has now agreed to a cap on our federal dollars, which means there will be limits that have never been placed on what can be spent in the Medicaid program," said Karen Woodall, spokeswoman for a coalition of advocacy groups. "In a year when they just announced that they have $3 billion in extra revenue coming in, it seems rather tragic that we're launching a major experiment with people's lives."
Mr. Bush said he wasn't concerned that many of the program's changes won't be implemented until after he has left office. "Powerful ideas implemented properly sustain themselves," he declared. "If it does work, and I believe it will, how can any future governor want to go back to a system that no one says works?"
In 2005, the Medicaid budget accounted for 24% of the state's annual spending, with projections that without changes it could grow to 59% of annual spending by 2015.
Florida's efforts to revise its Medicaid system, beginning with 200,000 people in Broward and Duval counties and then phased in statewide, ...Subscribe Now for Access
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